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ICC2 > complications of peptic ulcers > Flashcards

complications of peptic ulcers Flashcards

1
Q

what are the most important contributing factors to peptic ulcers ?

A

H.pylori
NSAIDs
acid and pepsin

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2
Q

what are the most important protective factors ?

A 
mucus
bicarbonate mucosal blood flow 
prostaglandins
hydrophobic layer 
epithelial renewal
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3
Q

what is considered the gold standard of h.pylori infection ?

A

histological identification

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4
Q

what are the methods of detection of H.pylori ?

A 
histological identification 
microbiological culture 
urease breath test 
rapid urease test 
serology for H.pylori antigen 
stool antigen test
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5
Q

which of the H.pylori tests require prior preparation ?

A

stool antigen test

urease breath test ( need to strop antibiotics and anti-acid medications)

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6
Q

what are one of the methods of detection of blood in the stool ?

A

guaic stool test

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7
Q

what is a succussion splash ?

A

is a sloshing sound heard through a stethoscope during sudden movement of the patient on abdominal auscultation

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8
Q

what are the differential diagnosis ?

A 
MI 
neoplasm 
pancreatitis 
pancreatic cancer 
diverticulitis 
GERD
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9
Q

what is the treatment plan for h.pylori ?

A

triple therapy:

Amoxicillin + Clarithomycin + Proton Pump Inhibitor

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10
Q

what is the treatment plan for a non h.pylori peptic ulcer?

A

proton pump inhibitor
H2 receptor antagonists to assist ulcer healing
treatment plan for up to 8 weeks

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11
Q

what are the complications of peptic ulcer disease ?

A

bleeding
perforation
obstruction

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12
Q

what is the presentation of gastrointestinal bleeding ?

A

tarry stool or coffee ground emesis

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13
Q

what is the presentation of perforation ?

A

history of PUD
air under diaphragm
abdominal tenderness

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14
Q

what is the presentation of gastric outlet obstruction ?

A 
pain worsening with food 
non-billous vomiting 
hypokalemia 
hyponatremia 
weight loss
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15
Q

what is the treatment for gastric outlet obstruction ?

A

endoscopic balloon dilatation

truncal vagotomy

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16
Q

what is the most common complication of peptic ulcers ?

A

bleeding peptic ulcer

17
Q

what is the most likely prognosis of bleeding peptic ulcer?

A

self-limiting

18
Q

what is the next best step in management in melena or hematemsis ?

A 
1.in a stable patient :
consider IV PPI therapy, along with early endoscopy within 24 hours along with early discharge 
2.in an unstable patient:
urgent endoscopy 
endostasis + IV PPI infusion
19
Q

If there is re-bleeding in an unstable patient with hematemesis or melena what is the next best step in management ?

A

consider :
repeat endostasis
mesenteric angiography/embolisation
surgery

20
Q

what are the levels of bleeding in peptic ulcers ?

A
  • on a microscopic level
  • mild
  • moderate
  • severe
21
Q

what is the clinical presentation of a bleeding peptic ulcer ?

A

hematemesis
melena / tarry stool
manifestations of progressive shock

22
Q

how to exclude false hematemesis ?

A

examination of the nose and pharynx

23
Q

what is the most common cause of hematemesis ?

A

bleeding varicies

24
Q

what is an important cause of hematemesis that must be excluded ?

A

portal hypertension

25
Q

what are the investigations required for bleeding peptic ulcer?

A

when the general condition of the patient is stabilized then an upper GI endoscopy

26
Q

when would testing for hematocrit ad haemoglobin be appropriate ?

A

hematocrit and haemoglobin is only useful a few hours after haemdilution

27
Q

what is the treatment for a bleeding peptic ulcer?

A

most of these cases stop spontaneously

conservative treatment should always be considered

28
Q

when should PPIs be started ?

A

they should be delayed until the first endoscopy is performed

29
Q

what are the endoscopic treatment options for bleeding peptic ulcers ?

A

injections with adrenaline
heat probes
haemostatic clips

30
Q

what is the next step in management if endoscopic therapy fails in a bleeding peptic ulcer ?

A

selective arterial embolisation prior to surgical intervention

31
Q

what are the indications of endoscopis treatment ?

A

ulcer seen to be actively bleeding

stigmata of recent bleeding

32
Q

when there is severe bleeding in a bleeding peptic ulcer which artery is most likely to be affected ?

A

gastroduodenal artery which can be fatal

33
Q

what are the signs indicating perforated PU ?

A

air under diaphragm on Xray

34
Q

what is the treatment for Perforated PU?

A

resuscitate with fluids crystalloids

IV ab if there is bacterial peritonitis

35
Q

what are the two types of obstructing peptic ulcer ?

A

acute from inflammatory swelling

chronic from cicatrix

36
Q

what are the complications of obstructing peptic ulcer ?

A

Antral stenosis

respiratory infection due to aspiration of vomit

ICC2 (42 decks)

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